A Virtual Discussion of
COVID = More Stress, More Anxiety
Susan Hoff kicked things off by referencing mental health as a critical issue during the COVID-19 pandemic. “Over the last five or six months, the majority of adults have reported feeling more socially isolated, with higher levels of stress, higher levels of anxiety, and those with existing mental health challenges have suffered even more,” she said. “And we know the impact on children has been considerable, particularly those who are facing economic challenges and other uncertainties in their lives.”
She reminded listeners that health is one of United Way’s key focus areas, and how it is inextricably linked with education and income, our other two focus areas.
Pre-COVID, she said, more than 130,000 kids across North Texas had emotional disturbances or addictive disorders. Now, with most students learning at home, “We know that these students and children have a harder time succeeding in school without support. We also know that higher levels of education contribute to lower levels of mental stress. In other words, psychological health is improved by education, and good mental health supports educational outcomes.”
Financial issues and health issues also often go hand in hand, she noted. “Those with high financial stress are twice as likely to report overall poor health. And people with depression and anxiety are three times more likely to go into debt. Each of these areas plays a major role and impacts the others.
Hoff also emphasized United Way’s North Star goal: To ensure that every North Texan, regardless of race or ZIP code, has the access and opportunity to reach their full potential.
‘A Moment of Not Thinking Clearly’
Mandy Austin introduced opening speaker Brad Hunstable, saying his “very important story shines a light on the importance of open and honest dialogue, and it will create opportunities for larger conversations on mental and emotional health.”
“It’s an honor to be here today,” Hunstable said. But, he continued, “I wish I wasn’t here, to be perfectly honest.
“I’m here to tell you a story that’s changed me forever. In the middle of COVID, on a beautiful sunny day, April 17, my best friend—my proudest moment of my life was seeing him born—my son Hayden took his life. It’s a day I’ll never forget, a pain I’ll feel forever.”
Hayden, who was just days before his 13th birthday, was a normal, athletic kid who showed no signs of depression, his dad said. In the time since Hayden died, Hunstable said, he’s learned that “suicide is not what I thought it was. I thought suicide was for people who were massively depressed, people who were schizophrenic, drug users.”
He called out the frightening statistics he’s since encountered: Suicide is the second leading cause of death age groups 10-14, 15-24 and 25-34. Hunstable says he believes Hayden, like many suicides, took his life in a moment of just not thinking clearly. “I think he just had a moment where he made a decision and did something he ultimately couldn’t get out of.
“I understand now that suicide is not always obvious. In fact, it’s not usually obvious,” he said. “Fifty percent of suicides have no previous mental health diagnosis.“
Hunstable reluctantly signaled to challenges ahead: “I believe we’ve got a social and emotional tsunami [coming] unlike we’ve ever seen in this country. It’s been coming for a while, but it’s gotten even worse because of COVID, the economic hardship, the lockdown, the stress, not going to school.
“It’s quite frightening, but I think it’s solvable, in fact I know it’s solvable. If you have a true medical diagnosis, we solve it with medicine. They’re all sorts of new studies and capabilities around that, but for everyone else, which is the vast majority of impulsive suicide, particularly in youth, it’s solvable.
“And how do we solve it? We teach resiliency and life skills, and social and emotional development.”
This fall, Hunstable said, Hayden’s story will be part of a national emergency PSA, and later a longer series on Netflix. For more information, visit haydenscorner.org.
Mental Health’s Biggest Challenges
Hoff asked the panel to outline some of the biggest mental health challenges they’re seeing right now.
Phil Ritter reiterated that the COVID pandemic has magnified a mental-health crisis already in the making. However, he said, “If there’s one bright spot about COVID in mental health, I think it’s that policymakers are recognizing it’s not just mitigation of the virus that we need to be dealing with, but that we also need to be addressing the long-term mental-health consequences.”
Kristin Guillory added that it’s “not just one thing contributing to mental illness or feeling heavy or depression. There are compounded things going on. In the matter of a moment, the world changed for a lot of people. Now what I knew yesterday has changed—and how do I deal with that? That’s traumatic, along with not being able to go out and see people. Many of us have experienced huge losses during this time.”
Another problem, and not only during this pandemic year, she said: “We are a society that says to push back how you feel. You’re not angry, don’t be angry, don’t be sad. That [attitude] doesn’t do anything to help. Research shows that when we push back these feelings, try to push them away, that harms our brain.”
Isolation and Lack of Socialization
Jessica Trudeau said she’s seeing a lot of negative impact from isolation and lack of socialization now, but that was also happening pre-pandemic. “Our children are experiencing a significant lack of socialization, in particular with their peers.” However, she added, “If the quality of interactions is strong, adults can show up in a way that can build social skills and buffer some of that impact.”
From a public health perspective, she said, “We do anticipate increased incidents of suicide and major depression [during and post-pandemic]. But, in long-term developmental research we see that children are resilient and flexible. When we look at a lack of socialization with peers or adults, what will buffer that the most is the quality of interaction in the household. We look at the developmental age of the child as well as the home environment.”
On the environmental side, she said, the most important things are how stressful the home is, whether the home is safe, whether there is violence at home, or food insecurity, and if the child is going back and forth between homes, whether the situations are similar between homes or incongruent. She also said it’s important to ask what type of exposure the child has. “Is it just technology and TV, or are there books and toys and ways that they can engage in an imaginative experience?”
The developmental factors differ depending on the child’s age. “With adolescents,” for instance, “their peer relationships are now often more important than their experiences with adults.” For young children, she said, “They’re going to be less likely to have long-term implications if the environment is nurturing and consistent, because their brains are still developing. However, they’re more likely to have long-term consequences if the home is unsafe and unstable.”
Finally, for all children, she said, “It’s important to keep a pulse on whether there are dramatic shifts in mood, eating and sleeping, and are they lasting for a one- to two-week period. That’s an indication that we need either to lean in as parents, or we need to connect that child with a professional.”
Finding the Right Tools, Breaking the Stigma
Stephanie Hollman said the she has personally dealt with depression and anxiety for as long as she can remember, from when she was a little girl. “The kind of work I’m in, a reality show, definitely isn’t healthy for the issues that I face” she said.
“It’s very important to have open communication and dialogue with friends and family”, she added. “I personally do well on medication. I’m on antidepressants, but when I get off them, I have a hard time stabilizing my mood. You just have to figure what works for you. I go on walks, I meditate—I found tools for my depression and my anxiety.”
When she first came out about a suicide attempt and her struggles with mental health, she was very nervous, she said. “I did it on camera. I was shocked at how many people messaged me and wrote me, telling me, ‘I’ve been through the same thing, and I’ve always felt embarrassed and I felt so alone.’ In my whole life I felt very alone, and different. I always felt like I was different than my friends. So, for me it was very freeing. I felt like I wasn’t hiding under this fake smile, and letting people in was very liberating, the best thing I’ve ever done in my life.”
Guillory agreed with Trudeau that children are, for the most part, resilient, but said that it’s also important to recognize that they feel deeply, and they go through things, and we sometimes don’t give youth the permission to say, “I’m not good.”
“We’ve got to allow them to not be OK, in a productive and healthy way,” Guillory said. “Particularly with youth of color, adults often think they’re misbehaving, so let’s send them to detention, instead of finding out what they need. … Sometimes we punish behavior that doesn’t need punishment; it needs support and intervention.”
‘Depressed? See Your Doctor’
Hoff asked each panelist for some suggestions for plugging that coming tsunami of mental-health concerns that Hunstable referenced.
Ritter noted that at Meadows Mental Health Policy Institute, they’ve long had a strategy around “It’s OK to say” regarding mental health—the importance of talking about mental health publicly, in the workplace, at school or university. “That stigma [the pressure to stay silent] is probably the greatest barrier to people getting help,” he said, “and one of the best ways to reach people is through a peer.”
At the system level, he said, “We’ve got to start realizing that mental health is a treatable health-care condition, like any other health–care condition. Unfortunately, that’s not the way our system is set up in America. We’ve got one system for primary care and another system for mental–health care and that latter system is under–capacitated and its stigmatized, so people don’t get help.”
Also, he noted the importance of leveraging primary care—pediatricians for kids and internal medicine for adults. “That’s the only way to create the critical capacity to treat the prevalence of mental illness in the community. Primary–care clinicians can treat 80 percent of mental illnesses, especially mild to moderate depression, and anxiety and substance–use disorders. I dream of a bumper sticker: ‘Depressed? See Your Doctor.’ That’s really the answer.”
Guillory said society must recognize the truth surrounding youth of color and their susceptibility to inadequate or nonexistent treatment for mental illness: A higher level of students of color are referred to detention and are suspended and/or expelled, when in reality they may need intervention rather than punishment.
She also said, for everyone, she’d advise asking a couple of questions that are a little better than, “How are you doing?” She explained, “When you ask that, I say, ‘Fine’ or ‘OK’ because I don’t know. So, let’s ask instead, ‘How are your thoughts?’ ‘If your life had a title right now, what would it be?’ or ‘If your life was a song, what would it be?’
“I may be better able to communicate with you by playing a song for you or writing a poem for you, and this is really for everyone. Going back to students of color, it’s not necessarily that they have different pain; it’s how it’s addressed. [We need to] get rid of implicit bias around race and gender and ability.”
Trudeau agreed with Guillory, noting that research shows all the way down to pre-kindergarten, the majority of children being removed from the classroom are African-American boys.
With regard to trauma, she said, in the laboratory classrooms at Momentus, “It’s all about the adult in the room. If the adult in the room is not aware of their own relationship to past trauma, is not ensuring that their own basic mental health needs are met, it’s going to be nearly impossible for them to show up for a child who is bringing their experiences of trauma into the classroom.”
Hoff closed the session by asking about any policy changes in the works regarding mental health.
Ritter said telehealth has been positively impacted by the pandemic, and policy change can help keep it growing. “Telehealth has absolutely just exploded in the field of mental–health care,” he said, “and it’s really the only modality that’s out there right now.” Teledoctors have been held back in recent years by state and federal policies such as not being able to practice across state lines, requiring an initial in-person visit, and not being able to prescribe certain medications over telehealth, he noted.
“But in this emergency, all those regulations, or at least most of them, have gone away, and it’s enabled people to get services and care when and where they need it that otherwise would not have happened. We’re finding that people are actually happier with telehealth—they don’t have to drive to the clinic, they don’t have to be seen going into a clinic.”
It’s up to mental-health care providers and the public to lobby to keep those emergency regulation waivers in place so that telehealth can itself remain healthy post-pandemic, Ritter said.
Guillory said that for anyone who finds themselves in any position of power, “I challenge you to use your voice and your position and your ear. Encourage [mental health] training wherever you are, in church, the community, school—and push and encourage long-term training. This isn’t a one-hour–training–session kind of thing.”
Finally, Trudeau said to remember, “Vulnerability is the gift we keep on giving for ourselves and one another. It’s OK to not be OK. We’ll get through this together—and remembering that can help remove us from isolation.”
This article was published on: Aug 13, 2020